| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item, nos, each |
2,497 |
2,155 |
$135K |
| A4554 |
Disposable underpads, all sizes |
2,113 |
1,883 |
$90K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
708 |
622 |
$82K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
454 |
431 |
$56K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
26 |
24 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
999 |
358 |
$1K |
| E0601 |
Continuous positive airway pressure (cpap) device |
45 |
30 |
$1K |
| E0570 |
Nebulizer, with compressor |
1,188 |
308 |
$463.90 |
| K0001 |
Standard wheelchair |
1,166 |
337 |
$370.42 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
787 |
313 |
$303.76 |
| K0003 |
Lightweight wheelchair |
325 |
63 |
$124.42 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
370 |
68 |
$120.81 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
135 |
69 |
$99.79 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
42 |
29 |
$48.96 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
706 |
173 |
$34.70 |
| A7015 |
Aerosol mask, used with dme nebulizer |
560 |
104 |
$14.89 |
| A4256 |
Normal, low and high calibrator solution / chips |
549 |
231 |
$9.11 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
605 |
118 |
$8.20 |
| A4259 |
Lancets, per box of 100 |
771 |
311 |
$6.93 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
73 |
12 |
$5.21 |
| 0003A |
|
106 |
86 |
$0.00 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
171 |
53 |
$0.00 |
| A4258 |
Spring-powered device for lancet, each |
33 |
23 |
$0.00 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
54 |
13 |
$0.00 |